Patient handout

Post-cardiac-arrest care — commotio cordis (R-on-T blunt chest impact)

PRODUCTION

1. Your condition

This handout is for post-cardiac-arrest care — commotio cordis (r-on-t blunt chest impact). Your care team identified this based on: rosc after commotio cordis cardiac arrest — young athlete with witnessed blunt precordial impact then immediate collapse.

Other reasons your team may use this plan: witnessed precordial blunt impact (baseball, lacrosse, hockey puck, karate strike) immediately followed by collapse — classic commotio cordis trigger (maron & estes 2010 pmid 20335586); young athlete (typical age 8–25) with witnessed sports-related sudden arrest with no known underlying cardiac disease — commotio cordis high on differential.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
norepinephrine	0.05-0.5 µg/kg/min titrate MAP ≥65	IV	continuous	SOAP-II PMID 20200382; first-line post-ROSC vasoactive (uncommon need in this cohort given structurally normal heart)
amiodarone	300 mg IV bolus → 150 mg if recurrent → 1 mg/min × 6h → 0.5 mg/min × 18h	IV	standard ACLS dosing	AHA 2020 ACLS Class IIb; recurrent VT/VF in post-arrest period suggests unmasked substrate and warrants channelopathy workup
epinephrine	1 mg IV q3-5 min during arrest	IV	standard ACLS	AHA 2020 ACLS
magnesium sulfate	1-2 g IV	IV	one-time + repeat for TdP	AHA 2020 ACLS Class IIa for TdP; QTc prolongation may emerge as unmasked LQTS substrate during post-arrest workup
propofol	5-50 µg/kg/min	IV	continuous; titrate RASS	PADIS 2018
fentanyl	25-200 µg/h	IV	continuous	PADIS 2018; analgesia (chest-wall trauma) + shivering suppression for TTM
metoprolol	25-100 mg PO BID	PO	BID	HRS 2017 PMID 28219760 — beta-blocker Class I for symptomatic LQTS or CPVT; PHASE-prevention if substrate unmasked during workup

Plan: Commotio cordis post-arrest phenotype — standard post-ROSC bundle + structural-disease exclusion + sports-return decision pattern (AHA 2020 + AHA 2016 commotio cordis statement PMID 27045128 + Maron 2009 PMID 19741059)

3. When to call your provider

Contact your care team if any of the following happen:

Repeat commotio cordis-like event → ED + EP urgent
New unmasked channelopathy or structural disease → EP + revise sports decision
Mental health crisis → psychiatry

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Refractory VF / pulseless VT despite ≥3 AED shocks + amiodarone — uncommon in commotio cordis (typically responds to first AED shock if delivered <3 min); failure suggests prolonged low-flow time or unmasked substrate(life-threatening)
Sternal fracture, cardiac contusion with reduced EF, hemothorax, or pulmonary contusion identified on CT chest — significant impact-related thoracic trauma
Unmasked structural disease (HCM, ARVC, anomalous coronary) or channelopathy (LQTS, Brugada, CPVT) identified during post-arrest workup — this transforms ICD decision from "no" to "yes"

5. Follow-up

Cardiology + EP follow-up at 2–4 weeks for echo + ECG + Holter; cardiac MRI at 4–6 wk if structural workup equivocal; genetic testing if family history positive; sports-return clearance shared decision (typically permitted after complete evaluation if no substrate); family CPR + AED training; advocacy for venue AED programs (LifeVest 4hold AED + USA Lacrosse / NOCSAE chest protector ND200 advocacy); mental health (PTSD common in athlete + family); school + team incident debrief

6. Sources

Guideline: AHA 2016 Scientific Statement on Eligibility & Disqualification Recommendations for Competitive Athletes — Task Force 13 (commotio cordis section) + Maron 2009 U.S. Commotio Cordis Registry + AHA 2020 ACLS / Post-Cardiac-Arrest Care + TTM2 + Sandroni 2021 neuroprog + HRS 2017 inherited arrhythmia consensus